A New Word for Discharge Summaries?

In this country, we bulked them up and renamed them Transition of Care Documents, and they made life more complicated in many ways. The Australians are thinking of a different name:

I ran into an Australian video clip on Twitter that proposes a renaming of the Hospital Discharge Summary. It advocates for the term Clinical Handover and stresses the importance of timely summaries from the hospital to the primary care provider as readmission rates are exceedingly high when discharge summaries are not issued on the same day the patient leaves the hospital.

They propose a name change because the story doesn’t end when patients are discharged; instead, patients are returning to where the bulk of their health care takes place, and just like the Americans, they need their home team to safely continue their care.

https://vimeo.com/307594856

Where I work, the fictionalized hospitals, Cityside, Mountainview and so on, are pretty good about sending out summaries right away. The problem here is the bulk of the documentation.

I think it was Obamacare that brought us the concept of a massive data dump at the time of discharge. Just like doctors are accused of interrupting within seconds of patients beginning to speak, when we receive a discharge summary, or whatever we want to call it, we are intuitively feeling a sense of dread and panic:

Quick, what do I need to know to care for this patient?

It’s gotten so cumbersome that we now have had to hire care coordinators to read the voluminous discharge notes for us, extract the essential information, put it in a standardized format and send it electronically to us providers, and then incorporating that summary in our Transition Of Care (TOC, CPT Codes 99495 or 99496) visit documentation.

Well meaning bureaucrats figured doctors need to know everything to assume care of a patient, so they created a system that, as with EMRs, obscures the essence of the transition of care. Here too, we can’t see the forest for all the trees.

Actually, I recently did get just an ER note from Cityside, elegantly formatted in their new EMR with a right sidebar containing past history, medication list and so on, almost like the left sidebar in my own eClinicalWorks. After five minutes desperately looking for what medication my patient was started on, I called their Medical Records Department and asked them what was prescribed. They couldn’t figure it out either. There was a section in the clinical note for treatment, but the new medication wasn’t there.

They put me on hold, and while waiting I finally found it on my own, in the sidebar under “Medications” with a discrete “New this visit” over it. In eClinicalWorks, the medication list in the side bar contains only what each patient was on before the visit started. Greenway’s EHS in my other clinic reconciles medications at the end of the visit instead.

There is no standard in the VHS-Betamax wars of EMRs.

I was able to educate the Cityside Medical Records person about how their own documentation is set up.

So, what would constitute a practical Clinical Handover note? The future lies in the past: Emulate the old fashioned, laconic yet conversational style of old (just like a verbal handover would be like):

Just like with my proposed aSOAP office note, we need to incorporate a down-and-dirty quick take at the very top of every massive medical document that doctors actually have time to read.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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